Handbook of Nutrition and Pregnancy pp 71-88 DOI https://doi.org/10.1007/978-3-319-90988-2_4
Bruce W. Hollis, Carol L. Wagner
Infant-Child category starts with
- No consensus on MINIMUM International Units (IU) for healthy infant of normal weight
- 400 IU Vitamin D is no longer enough
Was OK in the past century, but D levels have been dropping for a great many reasons.
FDA doubled the vitamin D level in milk in July 2016
- No consensus: range is 600 to 1600 IU – based on many randomized controlled trials
- Fewer infants were vitamin D deficient when they got 800 IU – RCT Feb 2014
- 1600 IU was the conclusion of three JAMA studies
1000 IU recommended in France and Finland – 2013 - appears to be a good level
A recommended level may be agreed upon around the world by 2020
- 5X less mite allergy after add vitamin D
- Child bone fractures with low vitamin D were 55X more likely to need surgery
- 75 % of SIDS had low vitamin D
- Children stayed in ICU 3.5 days longer if low vitamin D – Dec 2015
- 5 out of 6 children who died in pediatric critical care unit had low vitamin D – May 2014
Having a good level of vitamin D cuts in half the amount of:
- Asthma, Chronic illness, Doctor visits, Allergies, infection
Respiratory Tract Infection, Growing pains, Bed wetting
Need even more IUs of vitamin D to get a good level if;
- Have little vitamin D: premie, twin, mother did not get much sun access
- Get little vitamin D: dark skin, little access to sun
- Vitamin D is consumed faster than normal due to sickness
- Older (need at least 100 IU/kilogram, far more if obese)
- Not get any vitamin D from formula (breast fed) or (fortified) milk
Note – formula does not even provide 400 IU of vitamin D daily
Infants-Children need Vitamin D
- Sun is great – well known for 1,000’s of years.
US govt (1934) even said infants should be out in the sun
- One country recommended 2,000 IU daily for decades – with no known problems
- As with adults, infants and children can have loading doses and rarely need tests
- Daily dose appears to be best, but monthly seems OK
- Vitamin D is typically given to infants in the form of drops
big difference in taste between brands
can also use water-soluable form of vitamin D in milk, food, juice,
- Infants have evolved to get a big boost of vitamin D immediately after birth
Colostrum has 3X more vitamin D than breast milk - provided the mother has any vitamin D to spare
- 100 IU per kg of infant July 2011, Poland etc.
More than 100 IU/kg is probably better
Getting Vitamin D into infants
Many infants reject vitamin D drops, even when put on nipple
I speculate that the rejection is due to one or more of: additives, taste, and oils.
Infants have a hard time digesting oils, 1999 1997 and palm oils W.A. Price 1 2 3
Coconut oil, such as in D-Drops, is digested by infants. 1, 2 3
Bio-Tech Pharmacal Vitamin D has NO additves, taste, oil
One capsule of 50,000 Bio-Tech Pharmacal Vitamin D could be stirred into monthly formula
this would result in ~1,600 IUs per day for infant, and higher dose with weight/age/formula consumption
598 items in the category Infant/Child See also
- breastfed 962 items as of Sept 2017
- "BIRTH DEFECTS" 172 items as of July 2016
- Stunting OR “low birth weight” OR LBW OR preemie OR preemies OR preterm 1940 items as of Oct 2018
- "SUDDEN INFANT DEATH" OR SIDS 177 items as of Nov 2018
- Overview of Rickets and Vitamin D
- Youth category listing has
145 items along with related searches
How much Vitamin D
- 400 IU of Vitamin D provided no benefit to children (not a surprise) – RCT March 2018
- Preemies need 1,000 IU of vitamin D – RCT Sept 2017
- Premature infants (30 weeks) who got 800-1000 IU of vitamin D were much healthier – March 2017
- 10 Reasons why children no longer have healthy levels of Vitamin D
- Systematic review of effective Vitamin D interventions in children - perhaps 2019
- Vitamin D supplementation by only 1 in 60 US Children – JAMA June 2018
- Reasons for children having low vitamin D (proposed by 10 societies) - May 2018
- Third study found that Infants needed 1600 IU of vitamin D – JAMA RCT May 2013
Non-daily dosing of infant is as good or perhaps better
- Monthly 120,000 IU of Vitamin D during lactation worked well - May 2016
- Vitamin D required for breastfed infants – daily or monthly, infant or mother – Jan 2017
- Neonate loading dose of 30,000 IU vitamin D helped a lot – May 2014
- Somewhat similar to Vitamin K loading dose at birth and giving a child Vitamin A every 6 months
PDF is available free at Sci-Hub 10.1007/978-3-319-90988-2_4
While much has been written about the importance of vitamin D during the lifespan, its greatest impact appears to be during pregnancy and lactation, affecting not only the mother but her growing fetus and, later, growing infant. Controversy surrounds the daily requirement for vitamin D and what constitutes sufficiency during these critical periods. A growing body of literature supports the importance of vitamin D supplementation during pregnancy to achieve a total circulating 25(OH)D concentration of at least 40 ng/mL, the point at which the conversion of 25(OH)D to 1,25(OH)2D is optimized. This level is associated with a lower risk of comorbidities of pregnancy and better outcomes. During lactation, a maternal daily dose of 6000 IU vitamin D/d is effective and safe at elevating milk vitamin D delivery to the recipient infant in such a manner that those infants do not require an additional vitamin D supplement. These infants also achieve a comparable total circulating 25(OH)D concentration compared to infants supplemented with 400 IU/day. Further, past data suggesting that vitamin D is a teratogenic compound are not well supported in the extant literature. To the contrary, significant amounts of vitamin D are required during pregnancy to protect the mother and fetus and impart genomic imprinting on the fetus to ensure long-term health. With enhanced knowledge about vitamin D’s role as a preprohormone, it is clear that recommendations for supplementation should mirror what is clinically relevant and evidence-based.
- The function of vitamin D during pregnancy is diverse, involving genomic alteration that is involved in decreasing birth complications and infant asthma development.
- The vitamin D requirement during pregnancy and lactation has been greatly underestimated.
- Women should take 4000 IU/d vitamin D prior and during pregnancy.
- Lactating mothers should consume 6000 IU/d vitamin D to satisfy her requirement as well as the requirement of her nursing infant.
Obstetrical “Paranoia” with Regard to Vitamin D Administration During Pregnancy
We refer to this type of thinking as “medical lore”; however, in this particular case because it carries forth into current medical care, we view it with serious concern. It happens when medical students are taught something that is based on outdated data that have been carried through to the present. This is absolutely the case with the use of vitamin D during pregnancy. Why is this?
Because of the British experience with idiopathic infantile hypercalcemia attributed to hypervitaminosis D, a terrible inaccurate association occurred that had a profound effect on the potential of vitamin D supplementation, not only during infancy but also during pregnancy. In 1963, Black and Bonham-Carter  recognized that elfin facies observed in patients with severe idiopathic infantile hypercalcemia resembled the peculiar facies observed in patients with supravalvular aortic stenosis (SAS) syndrome. Shortly thereafter, Garcia et al.  documented the occurrence of idiopathic hypercalcemia in an infant with SAS who also had peripheral pulmonary stenosis, mental retardation, elfin facies, and an elevated blood concentration of vitamin D. This is an interesting observation because in 1964, when the article was published, there were no quantitative means of assessing circulating concentrations of vitamin D. In fact, at that time, it was not even proven that vitamin D was further metabolized within the body. By 1967, vitamin D was viewed by the medical community as the cause of SAS syndrome [26, 27]. As a result of the theory that maternal vitamin D supplementation during pregnancy caused SAS syndrome , animal models were developed to show that toxic excesses of vitamin D during pregnancy would result in SAS [29, 30]. In these earlier cases (22), vitamin D had nothing to do with the etiology of SAS. What was described as vitamin D-induced SAS syndrome is now known as Williams Syndrome [31, 32]. Unfortunately, vitamin D intake during pregnancy is still associated with SAS.
Williams Syndrome is a severe genetic affliction related to elastin gene disruption  that is caused by deletion of elastin and contiguous genes on chromosome 7 g 11.23. This syndrome is characterized by multiorgan involvement (including SAS), dysmorphic facial features, and a distinctive cognitive profile . Such patients often exhibit abnormal vitamin D metabolism, which makes them susceptible to bouts of idiopathic hypercalcemia . This relationship was suspected as early as 1976 . Subsequently, it was shown that children with Williams Syndrome exhibit an exaggerated response of circulating 25(OH)D to orally administered vitamin D . Thus, the fear of vitamin D-induced SAS is based on studies that are no longer valid yet continue to be cited and feared, and thus impact treatment.
Vitamin D during lactation – 6,000 IU mom or 400 IU infant (Hollis, Wagner chapter) – Aug 2018
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